AJNR Am J Neuroradiol. Access to this content is restricted to Neurocritical Care ON CALL subscribers. For a discussion of neonatal hypoxia, refer to neonatal hypoxic-ischemic encephalopathy. Annink, K. V., Franz, A. R., Derks, J. Bystanders provide basic life support(BLS) and apply an automated external defibrillator (AED) which delivers two shocks. Hypoglycemia can be solved with extra feedings of breastmilk or formula. The reason for this predilection is not entirely clear, but it has been suggested that the relative immaturity of Purkinje cells (which are normally exquisitely sensitive to ischemic damage) in neonates somehow protects the cerebellar cortex 1. Doctors should be gathering medical histories, conducting screens and tests for certain infections, and treating the mother so the infection doesnt get passed to the baby during birth. Read on to learn about well-established treatments for HIE as well as some that are still in the experimental phase. Polyhydramnios is when there is too much amniotic fluid. Reference #273 added: Lybeck A, Cronberg T, Aneman A, et al. While there are methods of attempting to shift the baby, it is often recommended that these babies be delivered via C-section. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. : While every pregnancy is different, and, therefore, the length of labor is different, there are certain indicators that medical personnel look for to see if labor is progressing normally. Findings: 2. A true knot is a knot that forms in an umbilical cord. Pneumonia is a bacterial lung infection that can cause the baby to develop breathing issues and oxygen deprivation. There are often secondary effects of hypoxia on cardiac myocytes, causing reduced cardiac output and causing further secondary neurological injury. Emedicine.medscape . eCollection 2022. Both the reversal sign and the white cerebellum sign indicate severe injury and a poor neurologic outcome 1,3. MeSH Choline Improves Neonatal Hypoxia-Ischemia Induced Changes in Male but Not Female Rats. In some cases, a low-lying placenta migrates out of the way as the pregnancy progresses, but if it does not, the risk of HIE can be reduced by delivering via C-section. Although cerebellar injury can be seen in neonates, it tends to be more common in older patients. Epub 2013 Feb 26. Fill out the form below or call 866-645-4072 to get answers and guidance today. There are a variety of possible treatments for HIE that are still in the experimental phase (some are undergoing clinical trials, while others are still being tested on animals). An important part of preventing PROM (and premature PROM, or PPROM, which is when the membranes rupture prior to 37 weeks of gestation) is screening for infections. Hypoxic-ischemic encephalopathy (HIE) is a dangerous form of brain damage that can affect unborn children and neonates (newborns). Radiographics. That means your mental state may not go back to what it was. Usually, the placenta stays attached to the uterus until delivery. This hyperintense signal does not represent hemorrhage, and it is believed to be caused by the accumulation of denatured proteins in dying cells. PMC Ischemic means a lack of blood supply to the organs. In many cases, there are no symptoms, but doctors are responsible for screening for risk factors (such as prior cervical insufficiency, a history of D&C procedures, previous traumatic birth, prior premature rupture of membranes, or uterine anomalies). In a placental abruption, the placenta separates partially or completely from the uterus early. Examples of umbilical cord issues include: The umbilical cord is attached to the placenta, which is a dense network of capillary beds and oxygenated tissue. 2013;40(3):164-71. The cervix is a structure between the uterus and vagina that normally stays closed during pregnancy. 8600 Rockville Pike They are usually intubated and have a history of prolonged resuscitation. Radiographics. HIE can be deadly. Although adults can experience hypoxic-ischemic injury, HIE most commonly occurs as the result of an oxygen-depriving event during or around the time of birth. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. For example, if you have hepatic encephalopathy, clearing toxins from your blood can fix any issues youre having with confusion, memory problems, or mood swings. Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children. Hypoxic-ischemic encephalopathy (adults and children). Sepsis refers to an infection that circulates through the blood and tissues, meningitis is inflammation of the membranes around the brain and spinal cord, and encephalitis is brain inflammation caused by a virus. Faan ARMD, Resnick SJ. During labor, unforeseen complications require prompt responses from medical teams; failure to follow proper protocols can result in HIE. If the babys MAS is not treated properly, they may suffer from HIE due to oxygen deprivation. Seventy percent of the seriously impaired patients never regained consciousness and non emerged from coma within five days; all of the patients with good outcome were alert within twenty hours after resuscitation. Seventy-five publications were selected for inclusion in this article based on their relevance to these topics. If it is occluded (blocked), compressed, or knotted, this can compromise the flow of oxygen and nutrients to the baby and cause injuries. T1 hyperintensities indicating cortical laminar necrosis become evident after two weeks. Practical Neuroimaging in Stroke. Our review emphasized evidence-based management practices for the clinician. , a form of brain damage, which often overlaps with HIE. Reference #9 added: Memar M, Geara SJ, Hjalmarsson P, Allberg A, Bouzereau M, Djarv T. Reference #37 added: Li L, Poloyac SM, Watkins SC, et al. Medical staff place the babies under special blue lights or under a fiber optic blanket in a process called, . The following are just a few examples of promising treatments: The Cochrane Review has published summaries of research on a variety of experimental and cutting-edge treatments for HIE. Pneumonia is a bacterial lung infection that can cause the baby to develop breathing issues and oxygen deprivation. How to prevent brain damage due to hypoxic-ischemic encephalopathy (HIE) remains a question that needs an answer due to its serious sequels of neonatal death or severe intellectual, cognitive, and motor disabilities [].Perinatal HIE causes 23% of neonatal deaths [2,3] and affects 1.5-2 per 1000 births in developed countries, but the number affected increases to 26 per 1000 in resource . Hypoxic ischemic encephalopathy (HIE) is a brain injury. The pathophysiology of HIE is now better understood, and treatment with hypothermia has become the foundation of therapy. (n.d.). {"url":"/signup-modal-props.json?lang=us\u0026email="}, Di Muzio B, Yap J, Baba Y, et al. Your doctor could recommend: Your outlook depends largely on whether your encephalopathy is reversible or irreversible. Hypoxic-ischemic encephalopathy (adults and children) or global hypoxic-ischemic injury is a common unfortunate consequence of prolonged resuscitation after cardiac arrest. Check for errors and try again. Read More Created for people with ongoing healthcare needs but benefits everyone. not neonates), also known as global hypoxic-ischemic injury, is seen in many settings and often has devastating neurological sequelae. Neurologic injury is caused by hypoxia (secondary to carbon monoxide toxicity, near drowning, etc.) Reference article, Radiopaedia.org (Accessed on 19 Jan 2023) https://doi.org/10.53347/rID-14025, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":14025,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/hypoxic-ischaemic-encephalopathy-adults-and-children/questions/1598?lang=us"}, Hypoxic-ischemic injury in older children and adults, Hypoxic-ischaemic injury in children and adults, older children: drowning and asphyxiation remain common causes, adults: more often a result of cardiac arrest or cerebrovascular disease, with secondary hypoxemia/hypoperfusion, diffuse cortical and deep grey matter including perirolandic cortex (most common), diffuse cortical and deep grey matter sparing the perirolandic cortex, perirolandic cortex (primary motor/sensory) and medial occipital lobes (primary visual cortex), diffuse edema with effacement of the CSF-containing spaces, decreased cortical grey matter attenuation with a loss of normal grey-white differentiation, decreased bilateral basal ganglia attenuation, it has been proposed that this finding is due to the distension of deep medullary veins secondary to partial obstruction of venous outflow from the elevated intracranial pressure caused by diffuse edema, the result is that the cerebral white matter is of higher attenuation than the cortical grey matter, linear hyperdensity outlining the cortex as well as linear cortical enhancement (later and less evident signs) correspond to. Front Pediatr. Doctors should administer antibiotics to decrease the risk of infection; in many cases, these babies need to be delivered via C-section because of the high risk of infection-related complications and umbilical cord compression issues. 2022 Nov 12;23(22):13983. doi: 10.3390/ijms232213983. Epub 2016 Nov 23. . not neonates), also known as global hypoxic-ischemic injury, is seen in many settings and often has devastating neurological sequelae. Unable to process the form. Those changes lead to an altered mental state, leaving you confused and not acting like you usually do. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, 6 Minutes of Exercise May Protect Brain From Alzheimer's, 'Disturbing' Rate of Adverse Events During Hospital Stays. Reference #182 added: Harmon MBA, van Meenen DMP, van der Veen A, et al. Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. sharing sensitive information, make sure youre on a federal Muttikkal T & Wintermark M. MRI Patterns of Global Hypoxic-Ischemic Injury in Adults. Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. To examine the pathophysiology of HIE and the state of the art for the clinical care of neonates with HIE. This hyperintensity can also be seen within a few days on FLAIR 3. Updated Table 9: Pharmacologica Options for Shivering Management. Without treatment, a baby suffering from HIE can develop permanent disabilities like cerebral palsy. Hypoxic-ischemic encephalopathy in adults and older children (i.e. This iswhen the umbilical cord is wrapped around the babys neck. But encephalitis can cause encephalopathy. Abstract: Hypoxic-ischemic encephalopathy (HIE), is one of the most frequent and dramatic urgency found in neurological brain diseases of adults. (2018, July 26). Click on the headers to access the full topic content. Saunders. Hypoxic-ischemic encephalopathyin adults and older children (i.e. (2009) ISBN:0750675373. Reference #260 added: Kim HJ, Park KN, Kim SH, et al. B., Rudiger, M., Bel, F. V., & Benders, M. J. Historically, the clinician has had little to offer neonates with HIE other than systemic supportive care. 3. Hypoxic ischemic encephalopathy (HIE) is a condition that happens when there is a loss of oxygen, which affects blood flow to the brain. Conditions that make a pregnancy high-risk include (but are certainly not limited to) the following: Women with high-risk pregnancies should be referred to specialists who can provide extra care and check-ups to make sure that they and their babies are healthy. Check for errors and try again. Reference article, Radiopaedia.org (Accessed on 19 Jan 2023) https://doi.org/10.53347/rID-14025, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":14025,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/hypoxic-ischaemic-encephalopathy-adults-and-children/questions/1598?lang=us"}. 2017 May;17(5):449-459. doi: 10.1080/14737175.2017.1259567. Uterine and placental complications that may cause HIE include: In some rare cases, a mothers uterus may tear during delivery. After around 37 weeks, the placenta starts to break down in preparation for delivery. If resuscitation does not work, they are placed on a breathing machine called a ventilator. eCollection 2023 Jan. Chen S, Liu X, Lin J, Mei Y, Deng K, Xue Q, Song X, Xu Y. or interruption of blood flow (usually from cardiac arrest or hanging). About 90 percent of the causes occur in utero, about 10 percent after birth. Why Doesn't the U.S. Have at-Home Tests for the Flu? Hypoxic Ischemic Encephalopathy Definition. (2009) ISBN:0750675373. As in younger patients, conventional T1 and T2 weighted images are often normal or demonstrate only very subtle abnormalities. 4. As you start to do your research on exactly what your childs diagnosis means, you may be bombarded with facts, information, and advice regarding HIE, and you may be lost as to where to turn next. For a discussion of neonatal hypoxia, refer to neonatal hypoxic-ischemic encephalopathy. Hypoxic-ischemic injury in older children and adults, Hypoxic-ischaemic injury in children and adults, older children: drowning and asphyxiation remain common causes, adults: more often a result of cardiac arrest or cerebrovascular disease, with secondary hypoxemia/hypoperfusion, diffuse cortical and deep grey matter including perirolandic cortex (most common), diffuse cortical and deep grey matter sparing the perirolandic cortex, perirolandic cortex (primary motor/sensory) and medial occipital lobes (primary visual cortex), diffuse edema with effacement of the CSF-containing spaces, decreased cortical grey matter attenuation with a loss of normal grey-white differentiation, decreased bilateral basal ganglia attenuation, it has been proposed that this finding is due to the distension of deep medullary veins secondary to partial obstruction of venous outflow from the elevated intracranial pressure caused by diffuse edema, the result is that the cerebral white matter is of higher attenuation than the cortical grey matter, linear hyperdensity outlining the cortex as well as linear cortical enhancement (later and less evident signs) correspond to. (2013). Reference #218 added: Piscator E, Goransson K, Bruchfeld S, et al. The COMACARE pilot study combines different hemodynamic targets (MAP 65-75mmHg versus 80-100mmHg) with low-normal or high-normal arterial carbon dioxide tension, and normal or moderately elevated arterial oxygen tension during the initial 36 hours following ROSC; however, interim results demonstrate no significant differences in NSE levels which is a surrogate of neuronal damage, although NIRS values, albeit a secondary outcome, were improved. Before Low blood sugar levels can cause brain cells to die, causing brain bleeds and HIE. By continuing to use this site, you are agreeing to our. In MAS, the baby inhales particles of his or her stool during labor. Treatment can last up to a week (or until the baby can maintain normal glucose levels); it can take longer in premature babies, those with infections, or those with low birth weight. Low Apgar score and asphyxia complications at birth andriskof longer-term cardiovascular disease: a nationwide population-based study of term infants. Prolonged cardiopulmonary resuscitation after a cardiac arrest during coronary intervention. Hypoxic Ischemic : Encephalopathy is diagnosed in newborn infants who have varying degrees of brain damage from perinatal asphyxia, reduced blood flow & oxygen, that. Current guidelines dictate that this therapy be given within six hours of the hypoxic-ischemic (oxygen-depriving) event. Statistic added: A recent single center study attempted to elucidate the factors that may lead to persistently poor outcome at 1 year post-arrest, and identified older age, Hispanic ethnicity and discharge disposition of home with outpatient services. At present, there is no true cure for hypoxic-ischemic encephalopathy (HIE). This makes grey matter more susceptible to hypoxic-ischemic injury 1. Reference #8 added: Salam I, Thomsen JH, Kjaergaard J, et al. Often, doctors recommend early delivery, usually via C-section, though induction can be an option as well. Please visit our page on long-term outcomes and care to learn more about maximizing function and minimizing negative symptoms in children with HIE. This can cause, (low CO2 levels), which in turn cause HIE and an injury called, (where the babys brain tissue starts to die and soften around the periventricular area). 1. Statistic added: Post hoc analyses of the TTM trial demonstrated a promising role of light chain neurofilament, Tau and admission lactate (although not lactate clearance). HIE Help Center is owned by ABC Law Centers (a birth injury law firm). Reversible causes include: Types of encephalopathy that are irreversible include: The symptoms you have depend on the type and cause of your encephalopathy, but some of the most common ones are: If you notice any of these symptoms in yourself or someone else, you should call your doctor or go to the emergency room. Reference #219 added: Matthews EA, Magid-Bernstein J, Sobczak E, et al. This site needs JavaScript to work properly. In reversible encephalopathy, such as from organ failure, metabolic conditions, or infections, symptoms usually go away when you fix the problem thats causing them, and you may be able to regain your previous mental abilities. Depth and duration of post arrest coma correlated significantly with poor neurologic outcome. Doctors should be screening for amniotic fluid issues with physical examinations and ultrasound during the pregnancy. to mature the babys lungs if they are preterm. Medical staff must be able to place the tube properly, or they risk the baby not having air delivered to the lungs at all, along with stomach tears and lung collapse. Application of amide proton transfer imaging for the diagnosis of neonatal hypoxic-ischemic encephalopathy. It happens when the brain does not get enough oxygen. In many cases, this means within six hours of birth (1). government site. In babies, HIE most often results from a medical complication and/or medical malpractice around the time of birth. Diffusion-weighted imaging abnormalities usually pseudo-normalize by the end of the 1st week 1. 2013 Aug;163(2):465-70. doi: 10.1016/j.jpeds.2013.01.041. Sepsis refers to an infection that circulates through the blood and tissues, meningitis is inflammation of the membranes around the brain and spinal cord, and encephalitis is brain inflammation caused by a virus. (n.d.). Issues with the uterus or placenta have the same impact as problems with the umbilical cord compromising the flow of oxygen and nutrients will harm the baby. Hypoxic-ischemic encephalopathy (adults and children), Hypoxic-ischaemic encephalopathy (adults and children). There are cases in which emergency interventions are needed, both in high-risk and low-risk pregnancies. This can in turn cause brain bleeds and. Bethesda, MD 20894, Web Policies Journal of Neuroradiology. Journal of Neuroradiology. Epub 2011 Apr 28. Some of these infections include: Depending on what the infection is, the baby may be diagnosed differently. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Di Muzio B, Yap J, Baba Y, et al. In some instances, HIE may not be preventable. 2012 Jan;32(1):15-20. doi: 10.1038/jp.2011.41. are often used to increase the strength of contractions and speed up labor. : PROM occurs if a mothers membranes rupture (water breaks) more than 18 hours before labor starts. Statistic added: A 2016 Canadian multicenter study utilized a multifaceted quality intervention consisting of education, pathways, local champions and audit-feedback, resulting in improved rates of appropriate neurologic prognostication, but without an increase in survival with good neurologic outcome. (2009) ISBN:0750675373. Monitoring requires staff to be able to recognize and properly read heart tracings; if medical personnel fail to recognize signs of distress or respond quickly enough, it is likelier that a baby will suffer HIE. In this group of patients, mild-to-moderate injury will manifest as watershed infarcts. However, in most cases, oxygen deprivation occurs due to a health issue that medical staff missed or mismanaged during pregnancy, birth, or delivery. Bookshelf They are therefore the sites most susceptible to the effects of glutamate excitotoxicity (i.e. Anti-Inflammatory Diets May Improve Fertility, Exercise May Be an Anti-COVID Secret Weapon, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox, MS Brain Fog? Neonatal HIE can lead to permanent brain damage and lifelong disabilities such as cerebral palsy (CP) and cognitive deficits. or interruption of blood flow (usually from cardiac arrest or hanging). Practical Neuroimaging in Stroke. This hyperintense signal does not represent hemorrhage, and it is believed to be caused by the accumulation of denatured proteins in dying cells. Diffusion-weighted MR imaging is the earliest imaging modality to become positive, usually within the first few hours after a hypoxic-ischemic event due to early cytotoxic edema. damage to nerve cells by excessive stimulation by glutamate). The normal attenuation of the grey and white matter is reversed (reversal sign) and the density of the cerebellum is relatively higher due to the hypoattenuation of the cerebral hemispheres (white cerebellum sign). : If a baby is not born after 40 weeks, this may be considered a post-term pregnancy (exact definitions vary). Excessive uterine contractions stimulated by induction drugs, Improper technique when using forceps or a vacuum extractor. This should involve regularly-scheduled ultrasounds and other tests such as Doppler flow, weight checks, amniocentesis, non-stress tests, and biophysical profiles. This hyperintensity can also be seen within a few days on FLAIR 3. Unable to load your collection due to an error, Unable to load your delegates due to an error. It is sponsored by ABC Law Centers, a birth trauma law firm that has represented families of children with HIE and other birth injuries for over 20 years. 4. All rights reserved. For example, a baby may have macrosomia (a condition in which they are unusually large) or there may be cephalopelvic disproportion (the babys head is too large to fit through the mothers pelvis). This makes grey matter more susceptible to hypoxic-ischemic injury 1. There are often secondary effects of hypoxia on cardiac myocytes, causing reduced cardiac output and causing further secondary neurological injury. Finally, a baby may move into the mothers abdomen following a uterine rupture, which is very dangerous because the babys movement may cause the umbilical cord to become stretched, compressed, or torn. Attorney Advertising Disclaimers | Privacy Policy | Sitemap | About the HIE Help Center, Diabetes or gestational diabetes (when a woman develops diabetes during pregnancy), High blood pressure or preeclampsia (when a woman develops high blood pressure during pregnancy), Intrauterine growth restriction, or IUGR (small baby), Multiples pregnancy (twins, triplets, or more), Use of tobacco or alcohol during pregnancy, A history of complications in previous pregnancies. There is diffuse cerebral edema with effacement of the sulcal spaces, ventricular compression and tonsillar herniation. It often happens in the womb, at birth, or in childhood. It may also be necessary to deliver via C-section before the membranes rupture, so the baby is not exposed to infection via vaginal delivery. 2. Most often it involves the cortex fairly diffusely along with the deep grey matter structures, particularly basal ganglia, however, many other patterns are observed 4: The predominance of grey matter injury is due to its high metabolic requirement for oxygen and glucose to supply a large number of synapses. Neurologic injury is caused by hypoxia (secondary to carbon monoxide toxicity, near drowning, etc.) Necroptosis Blockade Potentiates the Neuroprotective Effect of Hypothermia in Neonatal Hypoxic-Ischemic Encephalopathy. Although cerebellar injury can be seen in neonates, it tends to be more common in older patients. For a discussion of neonatal hypoxia, refer to neonatal hypoxic-ischemic encephalopathy. : Babies can develop yellow skin, poor feeding, and lethargy due to the increased concentrations of bilirubin (a product of the breakdown of red blood cells) after birth. not neonates), also known as global hypoxic-ischemic injury, is seen in many settings and often has devastating neurological sequelae. In addition to providing therapeutic hypothermia, medical professionals should very closely monitor babies with HIE for abnormalities in heart rate, breathing patterns, temperature, etc. Chapter 13 HYPOXIC-ISCHEMIC ENCEPHALOPATHYIN ADULTS Max Mulder and Romer Geocadin CLINICAL CASE A 42 year old woman has a witnessed collapse at a gym while exercising on a treadmill. The First Experience of Application the Umbilical Cord-Derived Human Autologous Mesenchymal Stromal Cells for the Rehabilitation Therapy of Premature Infants with Extremely Low Body Weight and Hypoxic-Ischemic Encephalopathy. They also may give you some other tests, such as: The treatment you need depends on whats causing your encephalopathy. Encephalopathy is not a single disease but a group of disorders with several causes. Hypoxic-ischemic encephalopathy in adults and older children (i.e. During the first 24 hours, there may be restricted diffusion in the cerebellar hemispheres, basal ganglia, or cerebral cortex (in particular, the perirolandic and occipital cortices) 1,3. The HIE Help Center serves as an informational resource guide for families of children with hypoxic-ischemic encephalopathy (HIE). Latest Updates February 21, 2019. Hypothermia and systemic supportive care form the cornerstone of therapy for HIE. The cervix is a structure between the uterus and vagina that normally stays closed during pregnancy. Amer, A. R., & Oorschot, D. E. (2018). Cerebral ischemia is a disease in which oxygen is not sufficiently supplied to the brain tissue, resulting in damage to the brain neurons and causing serious disability [1,2].To investigate the pathological mechanism and therapeutic approaches, hypoxic-ischemic encephalopathy (HIE) models have been used [3,4].Due to limitations of neuronal recovery in HIE, stem cell-based therapy has . Statistic added: The presence of gasping during out-of-hospital arrest was showing to be associated with higher rates of 1-year survival, regardless of the first recorded rhythm. There are certain levels of amniotic fluid that are considered normal. There are certain circumstances under which a baby with HIE may not be eligible for therapeutic hypothermia, such as extreme prematurity or a birth weight under 1,750 grams. This condition can be detected if a mother reports on-and-off bleeding during the second half of her pregnancy; doctors should be able to diagnose this using ultrasound. Once diagnosed, IUGR babies must be closely monitored and delivered early, as many of them do not fare well in labor. Neurologic injury is caused by hypoxia (secondary to carbon monoxide toxicity, near drowning, etc.) T1 hyperintensities indicating cortical laminar necrosis become evident after two weeks. ADVERTISEMENT: Supporters see fewer/no ads. The intake team at ABC Law Centers is here to listen to every detail of what you and your family may have gone through during labor and delivery. If they are born not breathing at all, they are resuscitated, first with positive pressure ventilation (PPV), and then, if the procedure is not successful, with several alternatives in an attempt to get the baby breathing again. Radiographics. Careers. , where cerebrospinal fluid leaks into the ventricles, enlarging them and interfering with the development of the cerebral cortex. Does phenobarbital improve the effectiveness of therapeutic hypothermia in infants with hypoxic-ischemic encephalopathy? Retrieved November 19, 2018, from, (n.d.). Babies with respiratory distress and MAS are admitted to the NICU, and are treated with some combination of airway clearance, ventilation, supplemental oxygen, surfactant therapy, steroid therapy, nitric oxide, ECMO or radiant warmer to maintain their body temperature, depending on the severity of the babys respiratory distress.
